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Stereotactic Body Radiation Therapy (SBRT) for treatment of adrenal gland metastases from non-small cell lung cancer

Behandlung von Nebennierenmetastasen nichtkleinzelliger Bronchialkarzinome mit extrakranieller stereotaktischer Strahlentherapie (ESRT)

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Background:

Metastatic disease from a non-small cell lung cancer to the adrenal gland is common, and systemic treatment is the most frequent therapeutic option. Nevertheless, in patients suffering from an isolated adrenal metastasis, a survival benefit could be achieved after surgical resection. Stereotactic body radiation treatment (SBRT) increase local tumor control and could be an alternative option. We present our initial institutional experiences with SBRT for adrenal gland metastases.

Patients and Methods:

Between July 2002 and September 2009, 18 patients with a non-small cell lung cancer and adrenal metastasis received SBRT. An isolated adrenal metastasis was diagnosed in 13 patients, while 5 patients with multiple metastatic lesions had SBRT due to back pain. Depending on treatment intent and target size, the dose/fraction concept varied from 5 x 4 Gy to 5 x 8 Gy. Dose was given with an isotropic convergent beam technique to a median maximum dose of 132% to the target’s central part.

Results:

The mean clinical (CTV) and planning target volume (PTV) was 89 cm³ (5–260 cm³) and 176 cm³ (20–422 cm³). A median progression-free survival time (PFS) of 4.2 months was obtained for the entire patient group, with a markedly increased PFS of 12 months in 13 patients suffering from an isolated metastasis of the adrenal gland. After a median follow-up of 21 months, 10 of 13 patients (77%) with isolated adrenal metastasis achieved local control. In these patients, median overall survival (OS) was 23 months.

Conclusion:

SBRT is a feasible and safe technique for lung cancer patients with adrenal gland metastasis. In patients with an isolated adrenal metastasis median OS of 23 months was excellent and comparable to data after surgical removal, but noninvasive. Acute side effects were mild.

Hintergrund:

Nebennierenmetastasen nichtkleinzelliger Bronchialkarzinome sind häufig, und die systemische Therapie ist die meistgenutzte Behandlungsoption. Im Fall von Patienten mit isolierter Nebennierenmetastase verzeichnen chirurgische Daten einen Überlebensgewinn nach einer Resektion. Die extrakranielle stereotaktische Radiotherapie (ESRT) bietet aufgrund der sehr guten lokalen Kontrolle eine nichtinvasive Alternative. Wir präsentieren unsere institutionellen Erfahrungen mit der ESRT von Nebennierenmetastasen.

Patienten und Methodik:

Zwischen Juli 2002 und September 2009 wurden 18 Patienten mit Nebennierenmetastasen bei nichtkleinzelligen Bronchialkarzinomen mit ESRT behandelt (Tabelle 1). Eine isolierte Nebennierenmetastase wurde in 13 Fällen diagnostiziert, 5 Patienten wurden aufgrund von Flankenschmerzen bei multipel metastasiertem Tumorleiden behandelt. Abhängig von der Behandlungsintention und dem Bestrahlungsvolumen variierte das Dosierungs-/Fraktionierungskonzept zwischen 5 x 4 Gy bis 5 x 8 Gy. Die Dosis wurde appliziert über eine isozentrische conformale Mehrfeldertechnik mit einem medianen Dosismaximum von 132% im Tumorzentrum.

Ergebnisse:

Das mittlere klinischen Zielvolumen (CTV) und das mittlere Planungszielvolumen (PTV) lag bei 89 cm³ (5–260 cm³) bzw. 176 cm³ (20–422 cm³) (Tabelle 2). Die mediane progressionsfreie Zeit (PFS) von allem Patienten lag bei 4,2 Monaten bei deutlich längerer PFS von 12 Monaten für die 13 Patienten mit isolierter Nebennierenmetastase (Abb. 2). Nach einer medianen Nachbeobachtung von 21 Monaten waren 10 (77%) dieser 13 Patienten lokal kontrolliert mit einem medianen Überleben von 23 Monaten (Abb. 3).

Schlussfolgerung:

ESRT ist eine praktikable und sichere Technik zur Behandlung von Patienten mit Nebennierenmetastasen nichtkleinzelliger Bronchialkarzinome. Das mediane Überleben von 23 Monaten der Patienten mit isolierter Nebennierenmetas-tase ist exzellent und vergleichbar mit chirurgischen Daten, dabei mit dem Vorteil der nicht invasiven Behandlungsmethode und geringer Nebenwirkungsrate.

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Holy, R., Piroth, M., Pinkawa, M. et al. Stereotactic Body Radiation Therapy (SBRT) for treatment of adrenal gland metastases from non-small cell lung cancer. Strahlenther Onkol 187, 245–251 (2011). https://doi.org/10.1007/s00066-011-2192-z

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  • DOI: https://doi.org/10.1007/s00066-011-2192-z

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